Marital Adjustment of Women Living in Two Different Provinces of Turkey and their Attitudes towards Violence against Women

Citation: Aktaş B, Baysal HY, Yilmaz M (2018) Marital Adjustment of Women Living in Two Different Provinces of Turkey and their Attitudes towards Violence against Women. Int Arch Nurs Health Care 4:105. doi.org/10.23937/2469-5823/15100105 Accepted: November 14, 2018: Published: November 16, 2018 Copyright: © 2018 Aktaş B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Marital adjustment is defined as the integration of a couple with different personality traits in a union in order to complement each other to achieve happiness and common goals [1].For the achievement of unity and solidarity in the family, the couple should agree on economic, managerial and psychosocial issues such as communication, value and goals, decision making, the way to conduct home-related activities, relationship with close relatives, making use of free time and income management, and thus they should establish marital adjustment.In case they fail to establish marital adjustment, there might be trouble in the unity and solidarity of the family which might lead to disagreement, emotional destruction, and dissolution in the family [2].and thus could be a source of problems in marriage [2,3].Several studies on the issue have determined that factors such as education level, economic status, marriage pattern, family structure, marital conflict and number of children affect marital adjustment [3][4][5][6].
Violence against women is a world-wide problem that should be tackled.Although violence is a phenomenon encountered different life cycles, domestic violence appears in a multidimensional way.According to the report released by the World Health Organization in 2002, violence occurs mostly in the family environment and is perpetrated particularly against women [7].Domestic violence against women is a serious public health problem that has social causes, destroys a woman's self-esteem, reduces her self-esteem, suppresses her, sets a negative example for children, and disrupts physical and psychological health [8].According to a survey conducted in Turkey, 40.3% of women living in urban areas and 46.6% of women living in rural areas are exposed to domestic violence [9].
Descriptions of women and men vary from one culture to another.In many societies, men and women are regarded as creatures different from each other.Therefore, both genders are considered to have their own possibilities, responsibilities, roles and status.Attitudes are approaches with cognitive, emotional and behavioral aspects that develop in a very long time.
The beliefs within the tendencies defined as attitudes involve cognitive, emotional and observable activities [10].
Attitudes towards violence, perpetration of violence and exposure to violence play a role in the spread and persistence of violence in society.Perception and identification of domestic violence is always shaped by the cultural values of the society and individuals.Therefore, when the perpetration of violence comes to the agenda as something adopted and justified by the society, it becomes very difficult to perceive whether it is violence or not [11].What actions are perceived as violence in a society depends on the characteristics of the social structure of that society.Whether people who live in a society perceive acts of violence as acts of violence, in other words, value judgements valid in the cultural structure determines the magnitude of violence [12].
In many societies, violence against women is perceived as an acceptable behavior and is considered as an ordinary characteristic of marriage.A woman's perspective of violence is shaped by the culture of the society she is in, current legal regulations in that society, and her education and socio-economic level [13].Several studies have demonstrated that that marital adjustment decreases as domestic violence against women increases [14][15][16].In İdiz's study (2009), a significant negative correlation was found between marital adjustment and domestic violence and its emotional, physical, verbal, economic and sexual violence sub-dimensions [14].In Işiloğlu's study (2006), domestic violence decreased as marital adjustment increased [15].Another study found a significant negative correlation between marital adjustment and domestic violence [16].
Determination of marital adjustment in women living in two culturally different provinces of Turkey, and of social attitudes how they define and perceive violence are expected to be effective to understand the causes of violence against women, to produce solutions for these causes and to improve social sensitivity.

Aim
The present study was conducted to investigate marital adjustment of women living in İzmir and Erzurum, provinces in the western and eastern parts of Turkey respectively, and their attitudes towards violence against women.

Methods
The study is a descriptive and cross-sectional one.The study was carried out between February 2015 and June 2015 in five Family Health Center (FHC), three of which were affiliated to the Erzurum Provincial Public Health Directorate and two of which were affiliated to the İzmir Provincial Public Health Directorate.The population of the study included 18-49 year old married women residing in Erzurum (eastern) and İzmir (western).Of these women, 303 who presented to the FHCs for any reason and volunteered to participate in the study comprised the study sample.Three of the FHCs were in three districts of Erzurum province selected through the cluster sampling method and two of the FHCs were in Çiğli district of İzmir Province selected through the random sampling method.The population of the region where the two family health centers in Çiğli in İzmir were located included people mainly from the eastern and southeastern Anatolian regions, and immigrants from Albania and Thessaloniki, a city in Greece.
Data collection tools used in the study were the Sociodemographic Characteristics Questionnaire, the Attitudes towards Violence against Women Scale and the Marital Adjustment Scale.

Sociodemographic characteristics questionnaire
The Questionnaire developed by the researchers includes 14 items questioning the participants' socio-demographic characteristics such as age, educational status, employment status, educational status of the spouse, employment status of the spouse, family income, family type, the number of children, the longest place of residence, length of the marriage, marriage pattern, decision maker in the family, exposure to violence and the type of the violence being exposed to.

The attitudes towards Violence against Women Scale
The scale was developed by Gömbül (2000) to de-the go" and the other spouse marks the option "to stay at home", if both spouses mark the option to be "on the go" 1 point, and if both spouses mark the option "to stay at home" 2 points, the total score to be obtained from the scale ranges from 0 to 60. (The minimum and maximum possible scores to be obtained from the scale were 0 and 60 respectively).Those who obtain ≥ 43 points from the scale are considered to have marital adjustment, and those who obtain less than 43 points are considered not to have marital adjustment.The Cronbach alpha internal consistency factor of the scale was 0.80, and the two semi-test reliability coefficient was 0.67 [18].
The statistical analysis of the data was performed with the Statistical Package for the Social Sciences (SPSS) 25.0 statistical package program.Number, percentage and nonparametric and parametric tests were used to analyze the data.Statistical significance level was accepted as p < 0.05.
Before the study was conducted, approvals were obtained from the Ethics Committee of Atatürk University Faculty of Health Sciences and Erzurum Provincial Public Health Directorate.To administer the Attitudes towards Violence against Women Scale and the Marital Adjustment Scale, the permissions were obtained from the scales' authors.In addition, the participants' verbal consent was obtained.

Results
Table 1 shows the comparison of socio-demograph-termine attitudes towards domestic violence against women.On the scale, there are 19 statements related to attitudes towards physical, emotional, economic and sexual violence perpetrated by the husband against the woman.Each statement is rated on a 5-point Likert scale ranging from 1 to 5 ("1 = strongly disagree", "2 = disagree", "3 = undecided", "4 = agree", "5 = strongly agree").The scale had a high level of validity (α = 0.82).While low scores obtained from the scale indicate the tendency towards detraditionalization and modernization, high scores indicate the opposite: tendency towards traditionalization and demodernization.The increase in the score means that the participant displays an approving attitude towards violence, whereas the decrease means that the participant displays a disapproving attitude towards violence [17].

Marital adjustment scale
The Scale was developed by Locke and Wallace (1959).The validity and reliability study of the Turkish version of the scale was conducted by Tutarel and Kişlak (1999).The scale is intended to measure marital satisfaction and marital adjustment.The scale consists of 15 items each of which has a different number of options.Each item is rated between 0 and 6, which varies according to the number of options.According to this, the 1 st item is scored between 0 and 6 points, the items 2 through 9 between 0 and 5 points, the items 10, 14 and 15 between 0 and 2 points and the items 11 through 13 between 0 and 3 points.The 12 th item is scored 0 points if one of the spouses marks the option to be "on

Discussion
The present study was conducted to investigate marital adjustment of women living in the western and eastern parts of Turkey, and their attitudes towards violence against women.While the Attitudes towards Violence against Women Scale score of the participants residing in İzmir was 72, that of the participants residing in Erzurum was 70 (Table 2).The increase in the score indicates that the participant displayed an approving attitude towards violence, whereas the decrease indicates that the participant displayed a disapproving attitude.Given the maximum score to be obtained from the scale is 95, the scores obtained by the participants residing in both cities suggest that they displayed an approving attitude towards violence although they had different life and marriage styles.
Similar to the present study, in Yaman and Ayaz's study (2010), about half of the women stated that they justified violence in case the woman cheated on her husband [19].In Naçar, et al. study, nearly one out of two women stated that they justified violence against women and that they would accept it if they were subjected to violence.In the same study, the participating women thought that the most important cause of their exposure to violence was their fault [20].Karataş, et al. found that women living in rural areas were exposed to domestic violence and they witnessed that other women in their neighborhood were exposed to domestic violence too, that they often remained silent on violence they were exposed to and that even in some cases, they justified those who perpetrated violence against them.They pointed out that the women were not very much eager to seek their rights against violence [21].
The Research on Domestic Violence against Women in Turkey on gender roles conducted in 2015 compared the results obtained in 2008 with the results obtained in 2014, and found that while in 2008, 5 out of 10 women agreed with the statement "Women should not argue with their husbands" which reflects traditional gender ic characteristics of women living in the east (Erzurum) and the west (İzmir) in terms of homogeneity.
The comparison of mean scores the participants obtained from the Attitudes towards Violence against Women Scale and its subscales are shown in Table 2.
The comparison of the mean scores obtained from the Attitudes towards Violence against Women Scale and its Emotional-Sexual Violence and Descriptive Myths subscales by the participants from İzmir with the mean scores obtained by the participants from Erzurum indicated that there was no statistically significant difference between them (p > 0.05).On the other hand, the mean scores obtained from the Economic Violence and Legitimizing myths subscales by the participants from İzmir were statistically significantly higher than the mean scores obtained by the participants from Erzurum (p > 0.05).While high scores obtained from the scale indicate an increase in traditionalization regarding attitudes towards violence, low scores indicate the opposite: increase in detraditionalization (Table 2).
The comparison of the mean scores obtained from the Marital Adjustment Scale by the women participating in the study is shown in Table 3.
The comparison of the mean scores obtained from the Marital Adjustment Scale indicated that the scores of the participants residing in İzmir were significantly higher than were those of the participants residing Erzurum (p < 0.05) (Table 3).
The relationship between the mean scores obtained from the Attitudes towards Violence against Women Scale and those obtained from the Marital Adjustment Scale is shown in Table 4.
The comparison of the relationship between the mean scores obtained from the Attitudes towards Violence against Women Scale and those obtained from the Marital Adjustment Scale indicated that the relationship was not significant (p > 0.05) (Table 4).roles, in 2014, 4 out of every 10 women agreed with the same statement.Likewise, while 47% agreed with the statement "men are responsible for the attitudes and behaviors of women" in the 2008 survey, the rate dropped to 42% in the 2014 survey.These results indicate that the number of women tolerating violence decreased within 6 years from 2008 to 2014.On the other hand, the results also showed that half of the women continued to adopt the traditional roles [22].
In contrast to the findings of the present study, in a study conducted with midwives in Turkey, the midwives tended to display unfavorable attitudes towards violence [23].In another study, none of the participants approved physical or verbal violence perpetrated against a woman just because she criticized her husband, opposed her husband or did not fulfill her husband's expectations [8].
The number of the participants who stated that a woman deserved violence if she cheated on her husband or did not fulfill her husband's wishes was lower in Hotun Şahin, et al. study than in other studies (4.2%) [24].
The socialization process dictates the woman since her childhood that she must acquiescently submit to all kinds of difficulties and problems brought on by life [20].Indeed, the results of this present study indicate that the submissive behavior has not changed.
In the present study, the attitudes displayed by the women residing in both provinces towards violence against women were similar.In Altinay and Arat's (2007) study, there was no significant difference between the regions regarding the view justifying wife beating.The women agreed that wife beating should be regarded legitimate.While the rate of women who said that no beating could be justified was 86% in the eastern Anatolia sample, it was 89% in the middle-west Anatolia sample [25].
In a Survey on Perceptions of Violence against Women conducted in Adana, Ankara, Istanbul, Izmir, Erzurum, Trabzon and Malatya, which represent seven geographical regions of Turkey, 84.3% of the women in the survey group stated that they would not accept violence in any way, that violence is violence whether it is severe or not, and that most importantly, violence is something that is extremely insulting and no form of violence can be justified.The women participating in the survey reported that they witnessed women in their environment being exposed to violence at various stages of their life, and that because the women exposed to violence were taught to justify it while they were growing up, they resigned themselves to violence as long as it is bearable or not very severe.In the same study, 8.5% of the women stated that violence towards women could be justified as long as it was not very severe [12].
In a study carried out with women aged 15-49 liv-ing in rural areas in Nigeria, women who were from the southern region of Nigeria, were Muslim and had low socioeconomic level tolerated domestic violence more [26].
In the current study, the mean scores obtained from the Marital Adjustment Scale by the participants living in İzmir and Erzurum were 45 and 42 respectively (Table 3).Of the participants, those who scored ≥ 43 were considered to have marriage compatibility and those whose score was ≤ 43 were considered not to have marriage compatibility.Comparison of the scores the participants obtained from the Marital Adjustment Scale suggested that those living in İzmir had somewhat better marital adjustment than those living in Erzurum.This difference is probably due to the fact that their marriage patterns were different.
In a study conducted with married men and women, the mean score they obtained from the Marital Adjustment Scale was 34, which suggests that the majority of the group was incompatible with marriage [18].In her study (2013) investigating women's marital adjustment, Yüksel and Dağ found that the participants' score was lower than the minimum mean score reflecting the presence of marital adjustment according to the original scale [27].In her study (2009) conducted with patients who presented to emergency clinics and outpatient clinics, Idiz (2009) found that 72.5% of the respondents were incompatible with their marriage [14].In Hoşgör's study, the participating women's mean marital adjustment score was 42.44 which was similar to that of the participating men [28].In their study of dyadic adjustment, Şendil and Korkut (2008) found the women's marital adjustment scores were above the minimum mean score required for marital adjustment [4].In her study (2014) conducted in India, Fatima stated that marital adjustment of women living in rural areas were weaker than that of those living in urban areas and that those whose length of marriage was less than 10 or who had socioeconomic level had better marital adjustment [29].In another study conducted with working and non-working women in India [30], the marital adjustment score was 44.25 for the working women and 52.05 for the non-working women, which suggests that non-working women's marital adjustment was better than that of the working women.In a study conducted with people who had late (over 35-years-old) or early (under 20-years-old) marriages in Pakistan, marital adjustment of individuals who married late was better than that of individuals married early [31].Contrary to findings of other studies in the relevant literature, in this present study, there was no relationship between the participants' marital adjustment and their attitudes towards violence against women (Table 4).In İdiz's study (2009), there was a significant negative correlation between marital adjustment, and domestic violence and its emotional, physical, verbal, economic and sexual violence sub-dimensions, and regardless of the type of the violence, marital adjustment decreased as domestic violence against women increased [14].In Işıloğlu's study (2006), the comparison between total domestic violence scores and dyadic adjustment scores revealed that marital adjustment decreased as domestic violence increased [15].Malkoç (2001) conducted a study to investigate the relationship between communication styles of married couples and their marital adjustment, and determined that individuals whose marital adjustment scores were lower had more destructive communication styles than did those whose marital adjustment scores were higher [32].A study conducted in Iran showed that determinants of marital adjustment such as problem solving, communication and family roles significantly influenced the women's quality of life [33].A study on domestic violence and the way violence affected the quality of marriage demonstrated that men were more aggressive than were women, and that aggression markedly increased marital instability and incompatibility in marriage [34].
Establishment of a harmonious marriage relationship not only increases the satisfaction and happiness the couple gets from marriage and each other, but also protects their psychological health in increasingly difficult socio-economic conditions in addition to other factors [24].

Conclusion
The difference between marital adjustment of women who live in the east and west of Turkey is considered to stem from their different marriage patterns.In addition, that the women living in the eastern provinces got married at an early age may have adversely affected their marital adjustment.Although the ages of the participants living in both provinces were similar, the lengths of their marriages varied, which probably stemmed from the difference between their ages at which they got married.
Although the women living in the east were exposed to violence more than did the women living in the west, both of them, in general, displayed similar attitudes towards violence.The women living in both regions generally displayed an attitude of acceptance of violence.It is recommended that programs be offered in the primary health care services that address issues related to gender behaviors in women, so that they can reflect on their behavior and attitudes towards violence against women.

Table 1 :
Socio-demographic characteristics of the women participating in the study.

Table 2 :
Comparison of the mean scores the participants obtained from the Attitudes towards Violence against Women Scale and its subscales.

Table 3 :
Comparison of the mean scores obtained from the Marital Adjustment Scale by the women participating in the study.

Table 4 :
Relationship between the mean scores obtained from the Attitudes towards Violence against Women Scale and those obtained from the Marital Adjustment Scale.